STUDY: ISTAN SIMULATIONS IMPROVE CODE BLUE RESPONSE TIME

Kelley Huseman MSN, RN-BC, spent 20 years as a critical care and intensive care nurse before joining a small community hospital in Pennsylvania, USA as a professional development specialist. One difference she quickly noted at the 130-bed Ephrata Community Hospital was the rare occurrence of a few code blues each month, far fewer than Huseman had seen during her nursing career. “I observed a few codes and realized they weren’t real smooth codes like I was used to,” Huseman said. “I thought if they could just practice more, they would get better at it.” In 2009, the hospital purchased iStan and The Nurse Residency Program and Huseman began to conduct unannounced code blue simulations. “I’d go in on weekends or at 2 a.m. in the morning and put him in a room, get him into a code blue scenario and put him in V-tach (ventricular tachycardia). I would call the emergency department and give them the heads up so they wouldn’t have to leave a busy ER to come to a drill,” says Huseman.

After witnessing improved performance within the ICU unit, Huseman decided to get all the departments involved in a code blue study. She published her results in the May/June Journal for Nurses in Staff Development in an article titled “Improving Code Blue Response Through the Use of Simulation.” During the study, Huseman measured response times for chest compressions, defibrillation and epinephrine administration before and after conducting mock code drills with iStan. The response times for start of chest compressions and epinephrine administration improved significantly. “I would call the code and start my stopwatch to see how long it would take people to show up. Getting there was not the issue. Getting people to actually start CPR was a big hurdle,” Huseman said. “I had to do a lot of education with the floor nurses that they need to start basic life support before the code team gets there.”

“When you have a code, someone has to establish themselves as a leader and nobody wanted to step forward and be in charge,” Huseman added. “They got much better at one person stepping up and saying ‘okay, they are in V-Tach, here is what we are going to do.’ ” Today, the hospital requires that every nurse participate in a code blue drill at least once a year, and Huseman generally conducts drills every month. “The staff really enjoyed working with iStan,” Huseman said. “But if I had seasoned nurses on a team that performed really poorly, I would let happen what would happen in a real-life situation. Having him die was really sobering for a lot of people.”

WAKEMED TRAINS EMS RESPONDERS IN ULTRASOUND

Over the past few decades, EMS providers have rapidly adopted hospital technologies-- from pulse oximetry to 12-lead ECG monitoring to capnography — that have allowed emergency responders to capture more accurate patient information and deliver better care. Amar Patel, director of the WakeMed Center for Innovative Learning, which is part of WakeMed Health and Hospitals in Raleigh, North Carolina, USA, believes that the next wave of technology for EMS will be ultrasound. “Ultrasound can help us manage and treat patients’ medical trauma more effectively,” says Patel. “It’s a tool that we need to embrace.” An emergency responder can use pointof- care ultrasound to conduct an enhanced Focused Assessment with Sonography in Trauma (eFAST) exam to check for fluid around the heart or in the abdomen, to diagnose a pneumothorax, or for ultrasound-guided vascular access.

“Knowledge is power. If I see that there’s blood in the belly and the blood pressure is low, it will change the treatment. I’m going to go to a trauma care center,” say Patel. “If I can diagnose a pneumothorax and tell the doctor he’s got a hole in his left lung, it will help speed up the management of the diagnosis and care.”

Patel recently began using a CAE Healthcare VIMEDIX ultrasound simulator to train emergency responders, and has found that simulation helps speed up the learning process. “Ultrasound is still a new thing to first responders. The VIMEDIX anatomy shows you everything that’s there. It helps students become comfortable with the probe direction and better understand what’s there as you move the probe.”

GLOBAL MEDIC 2012 ADVANCED TRAINING EXERCISE

iStan and METIman Prehospital were key players in a "Global Medic 2012” joint military exercise at Fort Hunter Liggett, California in June. Air Force, Army, Navy and Marine Corps units from across the United States participated in a two week exercise that simulated real-world missions.

iStan played a critical role in allowing Critical Care Air Transport Teams (CCATT) to provide "care in the air.” CCATT missions typically move critically ill or wounded service members from initial levels of care to Level One facilities in the United States or Germany.

METIman was used extensively in the Expeditionary Medical Support (EMEDS) tents. Wounded soldiers are transported to EMEDS tents for initial care and stabilization before being transferred to higher levels of care if necessary. The medical teams consisted of Air Force, Navy and Army medics working side-byside to evaluate and provide care to METIman. The joint simulation training provided insight into what to expect when physicians, nurses and medics deploy with joint-service operations.

10th ANNUAL COMBAT CASUALTY CARE COURSE

In July, the Armada de Chile conducted its 10th annual Combat Casualty Care Course, also known as C4. The event consisted of 158 students representing nine countries, including Argentina, Ecuador, Colombia, Paraguay, and Uruguay. A select group of civilians, including firefighters, governmental EMS and Red Cross responders, joined the exercise in order to increase readiness and share the lessons learned in the field.

The Chilean Navy offers the course in cooperation with the Defense Medical Readiness Training Institute (DMRTI) at Fort Sam Houston in Texas. Instructors from the Armada de Chile and other military branches, the Chilean Red Cross, the Chile Emergency Public Health Service and DMRTI conducted tactical field care, evacuation care and care under fire simulation exercises.

The Chilean American C4 was the first course of its type offered on the continent, and the first to incorporate simulation training. This year's participants trained with CAE Healthcare’s Caesar, iStan, ECS®-Emergency Care Simulator and METIman simulators. “We felt very confortable with the simulators, and the field tactical experience was incredibly real,” said CDR Carlos Rivera MD, director and instructor of the C4 course in Chile for 10 years.

Since 2003, more than 1,100 students have participated in the C4 field exercises, lectures and skill station training. The Chilean version of C4 is unique because it trains across the spectrum of combat care, including doctors and medics to Special Forces officers, in order to facilitate teamwork and “train the trainers.”

FUNDACIÓN INSTITUTO DE SIMULACIÓN MÉDICA (INSIMED)

In the heart of Bogotá, Colombia, the pioneering Fundación Instituto de Simulación Médica (INSIMED) has established a state-of-art simulation training facility with a mission to promote safety in healthcare. The center, which was built with $35 million USD in funding from the INSIMED foundation and the Dutch Foundation Aaspartam, is equipped with advanced surgical, imaging and patient simulators within simulated clinical settings. “We were created to train healthcare professionals and to improve patient safety through simulation or with novel ways of teaching,” says Dr. Marco Angel, administrative director. “We want to be a center everyone can rely on in Latin America.” The center offered several Advanced Trauma Life Support (ATLS) courses and Maternal Fetal Life Support (MFLS) before its official opening in late September.

“One of our main concerns is that our practitioners or residents train themselves with patients in their first years,” Dr. Angel said. “We want these people to go through 20, 30 or 40 cases on a simulator and face any kind of complication they might face first on a simulator. Any mistakes they were going to make in a patient can be made on a simulator so they can learn from the mistakes.” With two floors dedicated to hands-on simulation training, the center houses a simulated Intensive Care Unit (ICU) that will have a CAE Healthcare Human Patient Simulator (HPS) in 2013. Additionally, the center will house an obstetrics room devoted to reducing infant mortality, a surgical floor with CAE Healthcare’s EndoVR, LapVR and CathLabVR surgical simulators, and the only da Vinci Surgical System in Latin America dedicated solely to training.

“One whole floor is equipped with 10 laparoscopic surgical towers in an in-vivo surgery lab designed to train all kinds of surgeons with biomodels,” Dr. Angel said. INSIMED is a self-sustaining facility with no revenues from government or grants while offering simulation courses for reasonable fees. “We have training agreements with the main universities in Columbia and the main scientific societies, private companies and the main hospitals,” Dr. Angel said. The center also plans to measure the results of its simulation training. “It’s very difficult to run studies that measure patient safety,” Dr. Angel said. “Our first study will be a clinically controlled double- blind study on sepsis. We are going to train the intensive care unit residents here at INSIMED and the others won’t have training. Then we are going to try to see the differences.”

USC KECK SCHOOL OF MEDICINE

Before 2010, Assistant Professor of Clinical Anesthesiology Catherine Rodziewicz had never operated a human patient simulator. But Dr. Rodziewicz had to quickly adopt simulation training when the American Council for Graduate Medical Education (ACGME) revised the program requirements for Anesthesiology. New requirements by the ACGME mandate residents to participate in at least one simulated clinical experience a year. As a result, Dr. Rodziewicz’s Department Chair at the University of Southern California Keck School of Medicine asked her to incorporate high fidelity simulation into her teaching. “I jumped at the opportunity,” Dr. Rodziewicz says. “The department had a fully equipped mock operating room just adjacent to the main ORs, with an HPS simulator and anesthesia machine, but lacked someone committed to learning how to operate the simulator and run simulations for anesthesia residents.”

To get started in simulation, Dr. Rodziewicz attended training at CAE Healthcare’s headquarters in Sarasota, Florida, USA and attended the CAE Healthcare HPSN 2011 event in Tampa, Florida. By May 2011, she conducted her first one-day pilot workshops for the residents at the LAC+USC Medical Center. To further expand her knowledge, USC sent Dr. Rodziewicz to the Center for Medical Simulation in Cambridge, Massachussetts, to learn about debriefing. “That changed my life, because I learned the value of becoming an educator using simulation as a tool,” Dr. Rodziewicz said. She also began to work with the new Müse® software for the HPS simulator and helped develop new Simulated Clinical Experiences (SCEs) for anesthesia. “The Müse SCEs take much of the work out of starting up a simulation program and give instructors the capacity to create more stable clinical experiences,” she added.

During the 2011-12 school year, Dr. Rodziewicz ran full-day simulation workshops for 54 anesthesia residents, and covered acute myocardial infarction, anaphylaxis, malignant hyperthermia and local anesthesia toxicity. At the June 2012 graduation banquet, Dr. Rodziewicz’s residents surprised her with an award thanking her for incorporating high fidelity simulation into their training. This past July, she conducted her first summer orientation with the HPS simulator for the new residents, and learned just how far she had come in teaching with simulation in less than two years. “We covered basic inductions, airway management, team building and common anesthesia problems,” Dr. Rodziwicz said. “I used the HPS simulator and the remote laptop, and I stayed in the room with the new residents to keep them from getting too nervous. I did everything on the fly so I could influence how the scenario went. It built my confidence working with the new Müse platform.”

This year’s senior residents are the first graduating class at USC to have had three years of simulation training. Dr. Rodziewicz believes they will be better clinicians because of their training in rare clinical events and crisis resource management. “These residents are very engaged in wanting to improve the quality of healthcare,” Dr. Rodziewicz said. “They are a different generation. They want to change medicine. My vision is to eventually empower residents to get involved in their own quality improvement initiatives, using simulation as a tool to discover latent errors in systems, improve processes, prevent errors and improve patient safety.” Dr. Rodziewicz is currently enrolled in the Master’s of Academic Medicine program at USC and has a letter to the editor accepted for publication in the journal Simulation in Healthcare.

MADEIRA CLINICAL SIMULATION CENTER AT NÉLIO DE MENDONÇA HOSPITAL

In September, Portugal’s third simulation lab to integrate high-fidelity simulators opened in Madeira. Situated in the Atlantic Ocean between Europe and Africa, Madeira is a Portuguese Island that has invested greatly in its regional health system. The Madeira Clinical Simulation Center will focus on “train the trainer” activities for trauma and disaster management, emergency medicine, critical care, anesthesia and obstetric and pediatric emergencies.

Dr. Alberto João Jardim, president of the regional government, led the center’s official opening ceremony and tour on September 4. The Madeira Clinical Simulation Center aims to become a distinguished national and international training center with a mission to advance patient safety for disaster and trauma victims, deliver medical education in collaboration with Madeira University and improve the performance of professional healthcare teams.

Located within Nélio de Mendonça Hospital, the center has four simulation rooms, two debriefing rooms, and is fully equipped with CAE Healthcare simulators, including an HPS, two iStans, two METIman, a PediaSIM, a BabySIM, a ProMIS surgical simulator and the LearningSpace center management system. The medical director, Dr. Pedro Ramos, is a senior general surgeon and director of the hospital’s Emergency Department. MEDSIMLAB, a full-service medical simulation company based in Portugal, will help to implement the training program over the next two years.

THE CENTER FOR DOMESTIC PREPAREDNESS

Over the course of a month, the 100-bed hospital in Anniston, Alabama, might overflow with victims of smallpox, mustard gas, dirty bomb explosions, chemical poisoning, mass shootings or natural disasters—all simulated and dropped into a routine hospital setting. As part of the Center for Domestic Preparedness, the Noble Training Facility (NTF) is the only fully operational hospital in the U.S. dedicated to preparing all disciplines of healthcare for mass casualty events caused by weapons of mass destruction and natural disasters.

“We’re a little different from a training college where they are teaching the skills,” says patient simulator specialist Robi Mobley. “When they come to us, they already have the skills, and we throw them into the midst of a catastrophic disaster.” The Noble Training Facility has an emergency room, medical and pediatric ICUs, a pediatric unit, three operating rooms, labor and delivery rooms, a nursery and a collection of patient simulators that includes 12 METImen, five adult HPS and four pediatric HPS simulators.

Often, a facility or region will send a team of physicians, nurses, EMTs and medics to run through a scenario. “In a mass casualty situation, people could be pulled from all aspects of the hospital setting,” Mobley says. “We’ve even had CEOs and CFOs come in.

NATO CENTRE OF EXCELLENCE FOR MILITARY MEDICINE

The NATO Centre of Excellence for Military Medicine in Budapest, Hungary, introduced high-fidelity patient simulation into its training courses in 2011. In October, under the direction of MILMED COE Training Branch Chief Dr. Colonel Laszlo Fazekas, the center hosted a “train the trainer” course for military personnel who manage advanced first aid for battle casualties. Twelve experienced NATO medical instructors from Germany, Holland, Hungary and Romania participated in both classroom and field training. Using the CAE Caesar trauma patient simulator, they reviewed practical usage of tourniquets, bandaging and chest needle decompression.

Accredited by the North Atlantic Council in 2009, the MILMED COE serves NATO through education, training and validation of new battlefield methods and standards. The MILMED COE steering nations are Hungary, the Czech Republic, France, Germany, Italy, The Netherlands and Romania.

THE HANNAFORD CENTER FOR SAFETY, INNOVATION AND SIMULATION AT MAINE MEDICAL CENTER

THE HANNAFORD CENTER FOR SAFETY, INNOVATION AND SIMULATION AT MAINE MEDICAL CENTER

The Hannaford Center for Safety, Innovation and Simulation at Maine Medical Center serves a clinical and student population of nearly 5,000—and has long-term plans to expand its expertise to the community, the state and the northeast region. The largest tertiary and acute care hospital in the state, Maine Medical Center opened the simulation center as part of a forward-thinking strategy to invest in the future of high-quality, safe and effective healthcare in Maine. Medical Director Dr John “Randy” Darby, PhD, MD championed the center and led the interdisciplinary committee that created its business plan Professor.

“Many places were nicely equipped and under-utilized,” says Darby. “Some simulation centers buy equipment that gathers dust because it does not have an identified use in an identified program.”

“The real success was being able to engage our faculty from the day the doors opened,” Darby says. “We worked extremely hard to developed fairly robust simulation-based education programs from the get-go in nine a dozen specialties, including nursing and allied health.”

Maine Medical Center partners with Tufts University School of Medicine in a program created to help address the shortage of physicians in the state, particularly in rural areas. Theses students, who split their time between the Boston campus and Maine Medical Center, are also learning through simulation.

Within the next few years, the center’s outreach programs will begin to deliver simulation training to rural areas throughout the state. “We are very much hoping to join the vanguard of people using simulation to enhance and sustain rural healthcare training, which dovetails nicely with the mission of our medical school program,” Darby says.

Anesthesiologists, says Mahmood, have become the “eyes and ears of cardiac surgeons as incisions have become smaller. The transesophageal exam has become an incredible monitoring modality in the operating room for congenital heart surgery, valve replacement and other life-threatening situations.”

At Beth Israel Deaconess, resident cardiologists and anesthesiologists train twice weekly in sessions that last two to three hours. The center also offers one-week intensives to outside physicians, and those sessions are booked a year out.

Mahmood trains both residents and physicians on state-of-the-art imaging simulators, including the VIMEDIX system, which enables instructors to tailor their sessions to each learner. “Some images are universally challenging, and some are specific to the trainer,” Mahmood says. “The VIMEDIX metrics enable us to see how a learner got an answer.”

HAMAMATSU UNIVERSITY SCHOOL OF MEDICINE

The Hamamatsu University School of Medicine in Japan was one of the earliest adopters of high-fidelity patient simulation in the mid-1990s. In 2012, the university opened its new patient simulation center for medical students, residents, nurses and paramedics. Dr. Koji Morita, assistant professor and vice director at the university, oversees the simulation center.

At the center, anesthesia residents are required to pass a skills level qualification test on a patient simulator before they can treat a patient. Using CAE Healthcare’s HPS, the residents practice their responses to complications of anesthesia.

Several times a year, the simulation center hosts advanced courses in crisis management sponsored by the Japanese Society of Anesthesiologists, the Japan Society for Clinical Anesthesia and the Japanese Association for Medical Simulation. The physicians practice scenarios related to obstetric crisis cases, including massive bleeding and hemorrhagic shock, as well as scenarios for anesthesia, which include malignant hyperthermia, pulmonary embolism, anaphylactic shock and cardiac tamponade.

The university also invites high school students with an interest in medicine to half-day seminars with speakers. After the presentations, students spend an hour in the simulation center with the HPS, where they can touch and interact with the “patient” and check his vital signs.

MOUNT SINAI SCHOOL OF MEDICINE HELPS CENTER

The confrontational surgeon, the harried nurse and the headstrong resident are not part of most formal simulation scenarios. Yet one or all of them participate in mission-critical simulations at the Mount Sinai School of Medicine HELPS (Human Emulation, Education and Evaluation Lab for Patient Safety) Center in New York City. Dr. Adam Levine, director of the HELPS center, says the beauty of these improvised characters is they can enter the scenario at the most inopportune moment to unnerve the participants, distract with a question or disrupt with a potentially fatal error.

“We ramp up the emotional content of the simulations even at the junior level,” said Dr. Levine, who is also a professor of Anesthesiology, Structural and Chemical Biology, and Otolaryngology. “There is no sense being in that simulation if it’s not going to be high-stakes and have a lot of impact.”

An early adopter of simulation, the Department of Anesthesiology at Mount Sinai School of Medicine purchased the first commercial METI Human Patient Simulator (HPS) in 1994. Levine led initial simulations for anesthesia residents while helping to beta test the HPS. Eighteen years later, he and a core team of anesthesiologists use the HPS for high stakes simulation events for professional retraining, re-certification and remediation as well as resident training and undergraduate education.

A proponent of high-stakes simulation for both education and assessment, Levine admits that the HELPS center model is unique. “I know we are doing things very, very differently,” Dr. Levine said. “We're proud of the way we have created our program. We don’t use technicians or ancillary teachers. We use MDs to educate all of our students. We’ve been very prolific with only three or four core faculty and a team of dynamic anesthesiology resident educators.”

The center’s two simulation rooms are frequently booked solid daily, delivering thousands of simulation experiences a year and generating a self-sustaining revenue stream for the program. In addition to offering regular American Society of Anesthesiologists (ASA)-endorsed Maintenance of Certification in Anesthesia (MOCA) courses, the center conducts competency assessment for medical licensing bodies and retraining for anesthesiologists who have been on clinical hiatus.

The center has also become a distinguished site for remediating professionals after poor outcomes and evaluating teamwork and clinical teaching skills. “It’s much more challenging to evaluate and document judgment, professionalism and interpersonal skills,” Dr. Levine said. “But one can readily see these skills deteriorate in a simulated environment when the scenario takes a challenging and stressful turn.”

With expertise developed through years of resident and faculty training, the HELPS center is poised to see exponential growth in its simulation training for professionals. The HELPS center has previously trained adult critical care teams from New York Presbyterian Hospital and Memorial Sloan-Kettering Cancer Center (MSKCC), and most recently hosted MSKCC nurse practitioners and critical care fellows for a two-day simulation seminar on crisis management for pediatric patients. The training focused on keeping pediatric intensive care patients in-house to reduce hospital transfers.

Levine would like to see medical associations create simulation-based standards for professional assessment, reentry or retraining. “It’s talked about but not available,” Dr. Levine said. “People are aware simulation exists, and licensing and credentialing bodies have heightened awareness of patient safety and the desire to make medicine safer. I would like to see them promote high-stakes education and assessment instead of teaching with checklists and tasks.”

Levine and Drs. Samuel DeMaria, Jr., Andrew Schwartz and Alan Sim have co-edited The Comprehensive Textbook of Healthcare Simulation, which will be available in early 2013. The textbook is a 50-chapter reference guide that contains contributions from simulation leaders worldwide who represent more than 20 healthcare disciplines and center management.

“The textbook is a resource for everyone that is already in the game or being challenged to get in the game — educators, technicians, administrators,” Dr. Levine said. In the final chapter, Levine, DeMaria, Schwartz and Sim offer their predictions about how simulation will grow over the next century.

“Simulation is here to stay,” Dr. Levine says. “It will be embedded in all educational activities from student through post-graduate, and it will be used for education, assessment and maintenance for all healthcare providers. I hope the book will invoke others to get into simulation.”

FAULKNER STATE COMMUNITY COLLEGE

In a dark auditorium packed with more than 1,000 high school and college students, all eyes are transfixed on an emergency room reenactment. A medical team works to resuscitate a 17-year-old who was texting while driving and has suffered multiple injuries.

As the teen’s sister stands by his side and the mother wails for her son, the emergency room nurse delivers devastating news. In the final scene, the team zips the teenager into a body bag and wheels him away.

Faulkner State Community College launched its patient simulation program one year ago through its Fairhope Campus Nursing Program. In addition to teaching nursing students how to respond to traumatic auto injuries, the faculty is using simulation to try to prevent them.

The scenario was conceived by two of the college’s adjunct faculty: ER Nurse Carman Godfrey and Flight Nurse Valarie Rumbley. “Both of them see traumatic events on a regular basis, and they had seen numerous texting while driving injuries,” said Allen-Thomas. “It was their vision, and they had a really strong conviction about it.” The vision of FSCC is to encourage others to use simulation to reach their communities regarding the hazards of texting and driving. “Every day, I get 15 to 20 emails that say ‘thank you so much,’” Allen-Thomas says. “I know we’ve saved a life along the way.”

THE UNIVERSITY OF HUDDERSFIELD

Watching her grandchild at play, Angela Hope, senior lecturer and practice and skills coordinator for the University of Huddersfield’s School of Human and Health Sciences, was struck by how much we humans learn through play. “Children practice simulation when they play and then they learn to socialize around that,” Hope says. “Our nursing students often say that learning through simulation is simply fun. We have actually published articles about this.”

About 200 miles north of London, the university enrolls roughly 270 nursing students a year in a three-year course of study. The course’s growth of simulator use in the last five years has led to the development of a complete Simulation Suite that encompasses the first floor of a large building.

Inclusive in the suite housing an iStan and PediaSIM, are rooms for nursing fundamentals, critical care, occupational therapy, physiotherapy, pediatrics, midwifery studies and an operating theater. “The simulators have truly emerged as a critical teaching tool and are fully integrated into our curriculum,” Hope notes. “Simulation is a tool that is taking education and learning to such a fantastic level. There really is no limit to the possibilities.”

DARTMOUTH HITCHCOCK MEDICAL CENTER

In September of 2011, the community of Lebanon, New Hampshire simulated a high school chemistry lab explosion that involved four hospitals, the City of Lebanon police and fire departments, Golden Cross Ambulance Service and the entire student and faculty of Lebanon High School. “We wanted to test the emergency and disaster drill plans and the new DCon plan and decontamination equipment,” says Gene Streck, Simulation Tech for Dartmouth-Hitchcock Medical Center. “The school principal wanted to test the school’s emergency evacuation plan.”

The students, who were unaware that the drill was coming, had to be evacuated across a five-lane state road to a National Guard Armory, while local hospitals triaged the mock casualties amid the bustle of their fully operating emergency rooms. Both human patient actors and three patient simulators, including two iStans and a Pediatric ECS, suffered burns and blast injuries, including blast lung caused by the shock of the explosion. “I personally think that simulation centers will be brought more and more into disaster drill exercises,” says Streck.

SIMULATION IN MOTION: SOUTH DAKOTA

What’s bigger than a bloodmobile, travels on wheels and houses an entire patient simulator family? A Simulation in Motion - South Dakota traveling simulation lab. SIM South Dakota, a partnership between the South Dakota Department of Health and five hospitals, began delivering high-fidelity simulation instruction to rural emergency services providers in 2011.

The goal of the program, according to Administrator Sandra Durick, is to provide clinically contemporary education to every rural hospital ER and every Emergency Medical Service throughout South Dakota. “As fascinating as the trucks are, it’s the educational programming that is the backbone to the whole project,” Durick says. The programming includes scenarios such as cardiac arrest, anaphylactic shock, and respiratory distress.

Each of the 44-foot, custom-built trucks, which were produced by Rosenbauer America, houses a simulated ambulance, emergency room and family of iStans, PediaSIMs and BabySIMs. The labs offer training scenarios to healthcare providers and volunteers who may only see a critically ill patient only once or twice a year, enhancing confidence, competency, communication and teamwork. “We have seen fabulous results,” says Durick. “We’ve had phenomenal response from the EMS community and the rural hospital ER personnel, including physicians.”

UNIVERSITY OF SOUTH FLORIDA ATHLETIC TRAINING

As college football season was gearing up in 2011, CAE Healthcare's iStan patient simulator joined the University of South Florida Bulls for a one-time, interdisciplinary simulation. Dressed in a full football uniform, iStan suffered a rare but life-threatening spinal injury on the field. The entire sports medicine team responded.

USF conducts sports injury simulations with its athletic training majors, but this was first multi-disciplinary effort, with faculty and staff from the Sports Medicine and Orthopaedic Department, USF Athletics, the Sports Medicine and Athletic Related Trauma Institute (SMART), Tampa Fire Rescue and additional staff from the University of Tampa, St. Leo University and the Tampa Bay Buccaneers.

“They talked to each other for the first time about a scenario,” said Dr. Micki Cuppett, director of the Athletic Training Education Program at USF Health. “That was impactful. They continued the conversation after the debriefing.”

Local media covered the scenario, even recording iStan’s vocal responses to physician’s questions. Since that day, Cuppett has received a number of requests from college and professional sports programs who want to create similar training exercises.

Combat Casualty Care Course, Texas, USA

In July, the Armada de Chile conducted its 10th annual Combat Casualty Care Course, also known as C4. The event consisted of 158 students representing nine countries, including Argentina, Ecuador, Colombia, Paraguay, and Uruguay. A select group of civilians, including firefighters, governmental EMS and Red Cross responders, joined the exercise in order to increase readiness and share the lessons learned in the field.

Global Medic 2012 Joint Training, California, USA

iStan and METIman Prehospital were key players in a "Global Medic 2012” joint military exercise at Fort Hunter Liggett, California in June. Air Force, Army, Navy and Marine Corps units from across the United States participated in a two week exercise that simulated real-world missions.

NATO Centre of Excellence for Military Medicine,
Budapest, Hungary

The NATO Centre of Excellence for Military Medicine in Budapest, Hungary, introduced high-fidelity patient simulation into its training courses in 2011. In October, under the direction of MILMED COE Training Branch Chief Dr. Colonel Laszlo Fazekas, the center hosted a “train the trainer” course for military personnel who manage advanced first aid for battle casualties.

In September, Portugal’s third simulation lab to integrate high-fidelity simulators opened in Madeira. Situated in the Atlantic Ocean between Europe and Africa, Madeira is a Portuguese Island that has invested greatly in its regional health system. The Madeira Clinical Simulation Center will focus on “train the trainer” activities for trauma and disaster management, emergency medicine, critical care, anesthesia and obstetric and pediatric emergencies.

Study: iStan Simulations Improve Code Blue Response Time

Kelley Huseman MSN, RN-BC, spent 20 years as a critical care and intensive care nurse before joining a small community hospital in Pennsylvania, USA as a professional development specialist. One difference she quickly noted at the 130-bed Ephrata Community Hospital was the rare occurrence of a few code blues each month, far fewer than Huseman had seen during her nursing career. “I observed a few codes and realized they weren’t real smooth codes like I was used to,” Huseman said. “I thought if they could just practice more, they would get better at it.”

Fundación Instituto de Simulación Médoca (INSIMED), Bogotá, Colombia

In the heart of Bogotá, Colombia, the pioneering Fundación Instituto de Simulación Médica (INSIMED) has established a state-of-art simulation training facility with a mission to promote safety in healthcare. The center, which was built with $35 million USD in funding from the INSIMED foundation and the Dutch Foundation Aaspartam, is equipped with advanced surgical, imaging and patient simulators within simulated clinical settings.

The Hannaford Center for Safety, Innovation and Simulation at Maine Medical Center serves a clinical and student population of nearly 5,000—and has long-term plans to expand its expertise to the community, the state and the northeast region. The largest tertiary and acute care hospital in the state, Maine Medical Center opened the simulation center as part of a forward-thinking strategy to invest in the future of high-quality, safe and effective healthcare in Maine.

Innovation in Medical School Simulation

From anesthesia practice to point-of-care ultrasound to laparoscopic surgery, medical schools incorporate simulation into curriculums to provide the most current training for residents, students and even undergrads. They are using state-of-the-art simulation to prepare tomorrow’s physicians for a rapidly advancing healthcare environment. Medical school faculty are conducting research with simulators to assess new training methods. From laparoscopic surgery to point-of-care ultrasound to anesthesia delivery, CAE Healthcare delivers state-of-the-art simulation solutions that can meet the challenges of resident training, professional certification and competency assessment for physicians.

USC Keck School of Medicine, California, USA

Before 2010, Assistant Professor of Clinical Anesthesiology Catherine Rodziewicz had never operated a human patient simulator. But Dr. Rodziewicz had to quickly adopt simulation training when the American Council for Graduate Medical Education (ACGME) revised the program requirements for Anesthesiology. New requirements by the ACGME mandate residents to participate in at least one simulated clinical experience a year. As a result, Dr. Rodziewicz’s Department Chair at the University of Southern California Keck School of Medicine asked her to incorporate high fidelity simulation into her teaching.

Mount Sinai School of Medicine HELPS Center
New York City, USA

The confrontational surgeon, the harried nurse and the headstrong resident are not part of most formal simulation scenarios. Yet one or all of them participate in mission-critical simulations at the Mount Sinai School of Medicine HELPS (Human Emulation, Education and Evaluation Lab for Patient Safety) Center in New York City. Dr. Adam Levine, director of the HELPS center, says the beauty of these improvised characters is they can enter the scenario at the most inopportune moment to unnerve the participants, distract with a question or disrupt with a potentially fatal error.

Hamamatsu University School of Medicine
Shizuoka Prefecture, Japan

The Hamamatsu University School of Medicine in Japan was one of the earliest adopters of high-fidelity patient simulation in the mid-1990s. In 2012, the university opened its new patient simulation center for medical students, residents, nurses and paramedics. Dr. Koji Morita, assistant professor and vice director at the university, oversees the simulation center.

Innovation in Nursing Simulation

Nursing schools first adopted simulation to teach fundamental patient care and assessment skills. Today, they are creating complex, interdisciplinary scenarios mirror real-life and involve students from different specialties. Meanwhile, hospitals are saving time and reducing turnover by using simulation for nurse onboarding, assessment and retraining for new units. With a newly updated Program for Nursing Curriculum Integration (PNCI v5), more than 250 evidence-based training scenarios, and state-of-the-art patient simulation, CAE Healthcare allows both learners and professionals to suspend disbelief and immerse themselves in training that challenges their knowledge, abilities and critical thinking.

The University of Huddersfield, Huddersfield, United Kingdom

Watching her grandchild at play, Angela Hope, senior lecturer and practice and skills coordinator for the University of Huddersfield’s School of Human and Health Sciences, was struck by how much we humans learn through play. “Children practice simulation when they play and then they learn to socialize around that,” Hope says. “Our nursing students often say that learning through simulation is simply fun. We have actually published articles about this.”

Faulkner State Community College, Alabama, USA

In a dark auditorium packed with more than 1,000 high school and college students, all eyes are transfixed on an emergency room reenactment. A medical team works to resuscitate a 17-year-old who was texting while driving and has suffered multiple injuries. As the teen’s sister stands by his side and the mother wails for her son, the emergency room nurse delivers devastating news. In the final scene, the team zips the teenager into a body bag and wheels him away.

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Show us your innovation! Share videos of your simulation in action with an international community of clinical simulation educators and learners. We will post your scenarios on our Facebook page or YouTube channel, the CAE Healthcare Insider blog, or on our community resources pages.

METI Awards

The CAE Healthcare family of users is an extraordinary and passionate group of individuals from all levels of healthcare and every corner of the globe, dedicated to pushing the envelope of healthcare simulation and helping to save lives. The METI Awards is an international awards event dedicated to honoring excellence in healthcare simulation and providing a forum for CAE’s users to show their simulator in action and be recognized by their peers. Click Here to visit the 2012 METI Awards YouTube Channel.

2012 Educator Innovators

Vermont Tech

First Place

"Saving the New Year in Siberia"Novosibirsk State Medical University and Head Department of the MES of Novosibirsk region

Innovation in Emergency Medical Response

Emergency medical responders are using patient simulation today to practice lifesaving skills that require precision and speed, such as airway management. They’re creating interdisciplinary disaster scenarios to improve communications among different response teams. They are leading students through golden hour scenarios, covering all aspects of patient care from the point-of-injury to transport to the operating room. CAE Healthcare offers the most authentic training tools for the rigors of emergency medical response. The CAE Healthcare line of patient simulators and validated scenarios challenge the trainee’s clinical and critical thinking skills, providing the best possible preparation for emergency care without any risk to real patients.

WakeMed Center for Innovative Learning, North Carolina, USA

Over the past few decades, EMS providers have rapidly adopted hospital technologies-- from pulse oximetry to 12-lead ECG monitoring to capnography — that have allowed emergency responders to capture more accurate patient information and deliver better care. Amar Patel, director of the WakeMed Center for Innovative Learning, which is part of WakeMed Health and Hospitals in Raleigh, North Carolina, USA, believes that the next wave of technology for EMS will be ultrasound. “Ultrasound can help us manage and treat patients’ medical trauma more effectively,” says Patel. “It’s a tool that we need to embrace.”

University of South Florida Athletic Training Education Program, Florida, USA

As college football season was gearing up in 2011, CAE Healtcare's iStan patient simulator joined the University of South Florida Bulls for a one-time, interdisciplinary simulation. Dressed in a full football uniform, iStan suffered a rare but life-threatening spinal injury on the field. The entire sports medicine team responded.

Simulation in Motion:
South Dakota, USA

What’s bigger than a bloodmobile, travels on wheels and houses an entire patient simulator family? A Simulation in Motion - South Dakota traveling simulation lab. SIM South Dakota, a partnership between the South Dakota Department of Health and five hospitals, began delivering high-fidelity simulation instruction to rural emergency services providers in 2011.

Dartmouth Hitchcock Medical Center, USA

In September of 2011, the community of Lebanon, New Hampshire simulated a high school chemistry lab explosion that involved four hospitals, the City of Lebanon police and fire departments, Golden Cross Ambulance Service and the entire student and faculty of Lebanon High School.

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